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June 3, 2019

Why aren't today's surgeons as good with their hands? (Hint: Video games may be to blame.)

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    Medical students today not only have less time to practice surgical procedures than their predecessors, but many are entering school with less of the manual dexterity that is critical to performing surgical procedures—and their childhood hobbies may be to blame, Kate Murphy reports for the New York Times.

    Ready-to-present slides: General surgery market trends for 2019

    Do today's medical students lack fine motor skills?

    In medical schools today, "clumsiness is a growing concern," Murphy reports.

    Maria Siemionow, a transplant surgeon at the University of Illinois College of Medicine, who currently trains residents in how to perform surgeries under a microscope, said she's increasingly seeing surgical students who "don't have a good feeling about their hands." And these students are easy to spot. She explained, "They are already in their residencies and yet, they don’t have a good feeling about their hands and you observe them getting frustrated, they are impatient, there is blood all over."

    Some medical school instructors say that "good feeling" in the hands is usually acquired in childhood, and can be very hard to develop as an adult.

    Robert Spetzler, a brain surgeon and former president and chief executive of Barrow Neurological Institute, said he developed his manual dexterity playing the piano as a child. "The sooner you begin doing a physical, repetitive task, the more ingrained and instinctive that motor skill becomes," he said. 

    But medical school instructors note few of today's medical students grew up performing tasks that used to be more common, such as woodworking, or needlework, that involve fine motor control. Instead, they spent their childhoods engaging in activities that involve less dexterity, such as cell phone games and video games.

    Medical students today have less hands-on experience—and more to learn

    In addition to coming into medical school with less dexterity, medical students today may be getting less hands-on experience than previous generations because of a 2003 law that restricted work hours to 80 hours per week, Murphy reports.

    Some research estimates the 2003 limit on work hours caused medical residents to lose about one year of experience—and that lost experience may have real-world implications, Murphy reports. For example, she cited one study that found the more procedures a surgeon preforms, the more likely it is that their patients will experience fewer complications and shorter hospital stays. Their patients are also more likely to survive.

    At the same time, medical students today also have to master multiple types of surgery, including minimally invasive procedures that require scopes or radiation rather than open surgery. Though Murphy reports, medical students today may have an advantage to learning these new technologies as they sometimes require less manual dexterity and more of the skills used when "playing video games."

    But even with the advent of new surgical technologies, Siemionow said it's critical for future surgeons to have experience with hands-on tasks like sewing develop manual dexterity, as well as "three-dimensional imagination, planning, patience, and precision."

    "If you see the little stitch is pulled too tight or you glued something improperly, you have to repeat and learn how to do better," Siemionow said. "It's these basic skills you also need to be a surgeon."

    Should standards change?

    Siemionow said the influx of students that struggle with dexterity should serve as a "wake-up call" for medical schools.

    She noted that while some students can be coached to improve their dexterity and patience over time, "schools need to do more to encourage creativity and three-dimensional thinking."

    Siemionow and other experts also say that surgical programs may need to begin considering medical students' dexterity when choosing trainees.

    "We look at their grades and their test scores … but the reality of being a good surgeon has nothing to do with that," said Michael Lawton, current president and chief executive of Barrow Neurological Institute. "What matters is how they handle the instruments and what kind of touch they have with tissues, as well as how they react and adapt when under stress in the [OR]" (Murphy, New York Times, 5/30).

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